Provider First Line Business Practice Location Address:
5539 S 27TH ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68512-1648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-261-6212
Provider Business Practice Location Address Fax Number:
402-817-4949
Provider Enumeration Date:
08/03/2009